1. Short title
This Act may be cited as the “Outpatient Therapy Modernization and Stabilization Act”.
Outpatient Therapy Modernization and Stabilization Act
A BILL
To amend title XVIII of the Social Security Act to improve and ensure ongoing Medicare beneficiary access to outpatient therapy services, and for other purposes.
2. Moderating annual Medicare reimbursement changes
Waiving certain rules with respect to implementation of adjustments of relative value units for evaluation and management codes— Section 1848(c)(2) of the Social Security Act (42 U.S.C. 1395w–4(c)(2)) is amended—
in subparagraph (B)(ii)(II), by inserting after “Subject to clauses (iv) and (v)” the following: “and subparagraph (P)”;
in subparagraph (F), in the matter preceding clause (i), by striking “The” and inserting “Subject to subparagraph (P), the”; and
by adding at the end the following new subparagraph:
“(P) Evaluation and management codes—The Secretary shall not apply subparagraph (B)(ii)(II) (relating to limitation on annual adjustments in relative values) or subparagraph (F) (relating to budget neutrality adjustments) with respect to the implementation of adjustments of relative value units for the evaluation and management codes described in the final rule published by the Secretary in the Federal Register on November 15, 2019 (84 Fed. Reg. 62568, 62847–62860), for 2021 and each subsequent year.”
Increase in update factor— Paragraph (19) of section 1848(d) of the Social Security Act (42 U.S.C. 1395w–4(d)) is amended to read as follows:
“(19) Update for 2020 through 2025—The update to the single conversion factor established in paragraph (1)(C) for 2020 and each subsequent year through 2025 shall be as follows:
“(A) For 2020, 0.0 percent.
“(B) For 2021, 1.0 percent.
“(C) For 2022 and 2023, 0.5 percent.
“(D) For 2024 and 2025, 0.0 percent.”
3. Helping outpatient providers through the COVID–19 pandemic
Clarification— The third proviso of the third paragraph under the heading “Office of the Secretary—Public Health and Social Services Emergency Fund” in division B of the Coronavirus Aid, Relief, and Economic Security Act (Public Law 116–136) is amended by inserting “(including physicians, physical therapists, occupational therapists, speech language pathology therapists, audiologists, psychologists, social workers, and any other supplier enrolled through part B of the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.))” after “Medicare or Medicaid enrolled suppliers”.
Effective date— The amendment made by subsection (a) shall take effect as if included in the enactment of the Coronavirus Aid, Relief, and Economic Security Act (Public Law 116–136).
4. Making appropriate therapy services accessible through the Medicare telehealth program
Medicare beneficiary access to therapy services during national health emergencies—
Permitting qualified therapists to provide Medicare telehealth therapy services— Notwithstanding any other provision of law, with respect to Medicare telehealth therapy services furnished on or after March 1, 2020, with respect to an emergency period during 2020, a physical therapist, an occupational therapist, or a speech language pathologist who is enrolled under the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.), or a facility that is participating in such program, may furnish Medicare telehealth therapy services to Medicare beneficiaries during such emergency period under the same terms and conditions as Medicare telehealth services may be furnished by physicians or practitioners pursuant to the COVID–19 interim final rule.
Definitions— In this subsection:
COVID–19 interim final rule— The term COVID–19 interim final rule means the interim final rule entitled “Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID–19 Public Health Emergency” and published in the Federal Register by the Centers for Medicare & Medicaid Services on April 6, 2020 (85 Fed. Reg. 19230 et seq.).
Emergency period— The term emergency period means the COVID–19 emergency period (as described in subsection (g)(1)(B) of section 1135 of the Social Security Act (42 U.S.C. 1320b–5)) or any other subsequent emergency period during 2020 with respect to which an emergency declaration described in subsection (g)(1)(A) of such section is made.
Facility— The term facility means an agency, clinic, facility, hospital, and entity described in section 1833(a)(8) of the Social Security Act (42 U.S.C.1395l(a)(8)) that furnishes Medicare telehealth therapy services.
Medicare telehealth therapy services defined— The term Medicare telehealth therapy services means services identified by HCPCS codes 92507–92508, 92521–92524, 92526, 92601–92604, 92607–92610, 92626–92627, 92630, 92633, 96105, 96125, 97110, 97112, 97116, 97129–97130, 97150–97158, 97161–97168, 97530, 97535, 97542, 97750, 97755, 97760, and 97761–97763 (and as subsequently modified by the Secretary of Health and Human Services), and which may be furnished to Medicare beneficiaries through telehealth under section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) pursuant to the COVID–19 interim final rule.
Occupational therapist— The term occupational therapist means a qualified occupational therapist as that term is used in section 1861(g) of the Social Security Act (42 U.S.C. 1395x(g)).
Physical therapist— The term physical therapist means a qualified physical therapist as that term is used in section 1861(p) of the Social Security Act (42 U.S.C. 1395x(p)).
Speech language pathologist— The term speech language pathologist has the meaning given the term qualified speech-language pathologist in section 1861(ll)(4)(A) of the Social Security Act (42 U.S.C. 1395x(ll)(4)(A)).
Implementation— Notwithstanding any other provision of law, the Secretary of Health and Human Services may implement this subsection by program instruction or otherwise.
Services furnished beginning in 2021—
in paragraph (1)—
by striking “or a practitioner (described in section 1842(b)(18)(C))” and inserting “, a practitioner (as defined in paragraph (4)(E)), or a facility (as defined in paragraph (4)(G))”; and
by striking “individual physician or practitioner” and inserting “individual physician, practitioner, or facility”;
in paragraph (2)—
in subparagraph (A)—
by inserting after “located at a distant site” the following: “, or a facility that is a distant site,”; and
by striking “such physician or practitioner” and inserting “such physician, practitioner, or facility”; and
in subparagraph (C), by striking “as determined by the” and inserting “as determined by a”;
in paragraph (3)(A)—
in the subparagraph heading, by striking “Physician and practitioner” and inserting “Physician, practitioner, and facility”; and
by striking “a physician or practitioner receiving payment” and all that follows through the period and inserting “a physician, practitioner, or facility receiving payment under this subsection to the same extent as they apply to physicians, practitioners, or facilities under such sections.”;
in paragraph (4)—
in subparagraph (A), by inserting before the period the following: “, or a facility that furnishes a telehealth service to an eligible telehealth individual via a telecommuniciations system”;
in subparagraph (E), by inserting before the period at the end the following: “, and also includes, for purposes of this subsection, a physical therapist, an occupational therapist, and a speech-language pathologist”;
in subparagraph (F)(i)—
by striking “and office psychiatry” and inserting “office psychiatry”; and
by inserting before “, and any additional” the following: “, therapy services (identified as of April 1, 2020, by HCPCS codes 92507–92508, 92521–92524, 92526, 92601–92604, 92607–92610, 92626–92627, 92630, 92633, 96105, 96125, 97110, 97112, 97116, 97129–97130, 97150–97158, 97161–97168, 97530, 97535, 97542, 97750, 97755, 97760, and 97761–97763 (and as subsequently modified by the Secretary))”; and
by adding at the end the following new subpragraph:
“(G) Facility—The term facility means an agency, clinic, facility, hospital, and entity described in section 1833(a)(8) of the Social Security Act (42 U.S.C.1395l(a)(8)) that furnishes therapy services described in paragraph (4)(F)(i).”
by adding at the end the following new paragraph:
“(9) Treatment of telehealth therapy services—The geographic requirements described in paragraph (4)(C)(i) shall not apply with respect to telehealth services that are therapy services described in paragraph (4)(F)(i).”
Effective date— The amendments made by paragraph (1) shall take effect on the date of the enactment of this Act and apply to telehealth services furnished under the Medicare program on or after January 1, 2021.
5. Reducing unnecessary paperwork in the delivery of therapy services
In general— Section 1835(a) of the Social Security Act (42 U.S.C. 1395n(a)) is amended by adding at the end the following new sentence: “The requirement for review of a plan of care described in paragraphs (2)(C)(ii) and (2)(D)(ii) for outpatient physical therapy or outpatient occupational therapy services or speech-language pathology services, respectively, for an individual under the care of a physician shall be deemed to be met if either of the following is included in the individual’s medical record: an order for such outpatient physical therapy or outpatient occupational therapy services or speech-language pathology services, as the case may be, signed by a physician under whom the individual is receiving care; or a certification of the individual’s plan of care signed by a physician under whom the individual is receiving care.”.
Conforming amendment— Section 1861(p) of the Social Security Act (42 U.S.C. 1395x(p)) is amended by adding at the end the following new sentence: “The requirement for review of a plan of care described in paragraph (2) for physical therapy services furnished to an individual under the care of a physician (as so defined) shall be deemed to be met if either of the following is included in the individual’s medical record: an order for such physical therapy services signed by a physician under whom the individual is receiving care; or a certification of the individual’s plan of care signed by a physician under whom the individual is receiving care.”.